5 ms·

Price transparency plus high deductible plans would drive the cost of health insurance down. Health insurance is supposed to cover you for catastrophic health

Price transparency plus high deductible plans would drive the cost of health insurance down. Health insurance is supposed to cover you for catastrophic health issues that were previously unknown. For some reason it changed to also cover all your recurring or minor illnesses.

epistasis 5y ago
I'm not so sure. There's a lot of waste in all of our health care system, and many areas are served by few care providers. Transparency on prices without effective competition won't change much.
- spaetzleesser 5y ago
  You have to start somewhere. Knowable prices are the first prerequisite for markets.
  - epistasis 5y ago
    That's an excellent point! It can't hurt, and might help. I don't know why I felt negatively about it at first, anything to start disrupting the bad parts of the system should be welcome.
alasdair_ 5y ago
Part of that is because it’s far cheaper to catch (say) cancer at an early stage and treat it than it is to catch it at stage 3 or 4 and spend potentially millions on a possibly preventable catastrophe. There is fairly strong evidence that if the cost of routine preventative care isn’t paid by insurance, quite a lot of people opt to skip it because they can’t afford it, leading to worse outcomes.
- jdlshore 5y ago
  > leading to worse outcomes. Do you have evidence of this part specifically? Because the Oregon Experiment found no improvement in health outcomes in a large randomized trial of low-income recipients of Medicaid. (Partly because their health was generally good in the first place.) https://en.wikipedia.org/wiki/Oregon_Medicaid_health_experiment https://en.wikipedia.org/wiki/Oregon_Medicaid_health_experim...
  - hanniabu 5y ago
    I had no health insurance so put off on a specialist i needed to see until i could sign up for medicaid (can only apply at the end of the year for some retarded reason). Just putting my issues off for 4 months turned an easy thing to fix into needing to spend the past 8 months in and out of the doctors and hospital.
    - Volundr 5y ago
      If the plural of anecdote is data, when the ACA was first rolled out, someone close to me discovered they had colon cancer. They had been having symptoms for quite some time, but had been managing them with home treatment, the first day the had insurance they went to get it checked out. Lucky they did, as devastating as it was (and continues to be, turns out your chemo is brutal and having large sections of your colon removed isn't great either) their doctors already weren't sure they could treat it effectively. While they credit the ACA with saving their life, had we had some form of socialized medicine from the start, this likely would've been caught much earlier, treated much more easily, and with significantly less long term effects. I couldn't easily find studies on preventative care leading to better outcomes, but given how many diseases (like cancer for example) can go from easily treatable to a catastrophic nightmare depending on how early they are detected, I find it hard to believe that easy, cheap (or free) access screenings would have no effect on outcomes, though I realize how treacherous it can be to rely on instinct instead of data.
      - jdlshore 5y ago
        Counterintuitive as it may be, the Oregon Experiment showed increased costs. It did show an improvement is psychological outcomes, I presume due to peace of mind, because their wasn’t a corresponding increase in psychiatric medication.
        freeone3000 5y ago
        Did the increase in cost also come with an increase in outcomes? I don't think it's counterintuitive that people who couldn't afford healthcare see a doctor, you'll see a lot of issues; did we see a decrease in medical issues across the population?
- nradov 5y ago
  The Accountable Care Act (Obamacare) requires most health plans to cover several screening services at no cost to the patient. https://www.healthcare.gov/coverage/preventive-care-benefits/ https://www.healthcare.gov/coverage/preventive-care-benefits...
riverlaw2 5y ago
I agree with your take. I work in the industry. The for some reason has partly to do with the U.S. tying insurance to your employer and not charging taxes. It makes sense to offer as much as possible pretax.
acdha 5y ago
It’d help a little but it’d still be a long way from an Econ 101 market. Preventative care is hugely effective at reducing costs but high-deductible plans ensure that many people will not get it. Many people simply aren’t capable of shopping around, either: emergency care, cognitive impairments, limited geographic options, and the conflicts of interest inherent to for-profit medicine all make it hard for people to know what they need and whether it’s worth the money. As with preventative care, making it harder to get treatment is certain to lead to many people not getting problems treated prior to them becoming major.
- warble 5y ago
  You don't need everyone shopping around. You just need enough to drive the market, it isn't even necessarily a majority.
  - acdha 5y ago
    Kind of like how list price means everyone pays the same price for a car? What would happen is more of what we already see: tons of addons being pushed, rebates or other ways to adjust prices for some people without lowering them, random specialists and unnecessary services being pulled in relying on the fact that most people don’t realize they can and should say no, and a whole industry of people finding ways to say you had some obscure complications not covered by the standard price. Look at it from an economic incentive standpoint: Americans pay 2-3 times more for the same service. That is a huge amount of money, and it ensures that rooms full of smart people will be working to ensure that their employers continue to get it.
    - bushbaba 5y ago
      Flip side you can actually shop around for the best car price. Can’t even do that at us hospitals
      - acdha 5y ago
        Exactly - it’s not a normal market and there are hard limits preventing it from ever working like that, no matter how many people desperately try to pretend otherwise because it’s personally profitable for them.

epistasis 5y ago

I'm not so sure. There's a lot of waste in all of our health care system, and many areas are served by few care providers. Transparency on prices without effective competition won't change much.

spaetzleesser 5y ago
You have to start somewhere. Knowable prices are the first prerequisite for markets.
- epistasis 5y ago
  That's an excellent point! It can't hurt, and might help. I don't know why I felt negatively about it at first, anything to start disrupting the bad parts of the system should be welcome.

alasdair_ 5y ago

Part of that is because it’s far cheaper to catch (say) cancer at an early stage and treat it than it is to catch it at stage 3 or 4 and spend potentially millions on a possibly preventable catastrophe. There is fairly strong evidence that if the cost of routine preventative care isn’t paid by insurance, quite a lot of people opt to skip it because they can’t afford it, leading to worse outcomes.

jdlshore 5y ago
> leading to worse outcomes. Do you have evidence of this part specifically? Because the Oregon Experiment found no improvement in health outcomes in a large randomized trial of low-income recipients of Medicaid. (Partly because their health was generally good in the first place.) https://en.wikipedia.org/wiki/Oregon_Medicaid_health_experiment https://en.wikipedia.org/wiki/Oregon_Medicaid_health_experim...
- hanniabu 5y ago
  I had no health insurance so put off on a specialist i needed to see until i could sign up for medicaid (can only apply at the end of the year for some retarded reason). Just putting my issues off for 4 months turned an easy thing to fix into needing to spend the past 8 months in and out of the doctors and hospital.
  - Volundr 5y ago
    If the plural of anecdote is data, when the ACA was first rolled out, someone close to me discovered they had colon cancer. They had been having symptoms for quite some time, but had been managing them with home treatment, the first day the had insurance they went to get it checked out. Lucky they did, as devastating as it was (and continues to be, turns out your chemo is brutal and having large sections of your colon removed isn't great either) their doctors already weren't sure they could treat it effectively. While they credit the ACA with saving their life, had we had some form of socialized medicine from the start, this likely would've been caught much earlier, treated much more easily, and with significantly less long term effects. I couldn't easily find studies on preventative care leading to better outcomes, but given how many diseases (like cancer for example) can go from easily treatable to a catastrophic nightmare depending on how early they are detected, I find it hard to believe that easy, cheap (or free) access screenings would have no effect on outcomes, though I realize how treacherous it can be to rely on instinct instead of data.
    - jdlshore 5y ago
      Counterintuitive as it may be, the Oregon Experiment showed increased costs. It did show an improvement is psychological outcomes, I presume due to peace of mind, because their wasn’t a corresponding increase in psychiatric medication.
      - freeone3000 5y ago
        Did the increase in cost also come with an increase in outcomes? I don't think it's counterintuitive that people who couldn't afford healthcare see a doctor, you'll see a lot of issues; did we see a decrease in medical issues across the population?
nradov 5y ago
The Accountable Care Act (Obamacare) requires most health plans to cover several screening services at no cost to the patient. https://www.healthcare.gov/coverage/preventive-care-benefits/ https://www.healthcare.gov/coverage/preventive-care-benefits...

riverlaw2 5y ago

I agree with your take. I work in the industry. The for some reason has partly to do with the U.S. tying insurance to your employer and not charging taxes. It makes sense to offer as much as possible pretax.

acdha 5y ago

It’d help a little but it’d still be a long way from an Econ 101 market. Preventative care is hugely effective at reducing costs but high-deductible plans ensure that many people will not get it. Many people simply aren’t capable of shopping around, either: emergency care, cognitive impairments, limited geographic options, and the conflicts of interest inherent to for-profit medicine all make it hard for people to know what they need and whether it’s worth the money. As with preventative care, making it harder to get treatment is certain to lead to many people not getting problems treated prior to them becoming major.

warble 5y ago
You don't need everyone shopping around. You just need enough to drive the market, it isn't even necessarily a majority.
- acdha 5y ago
  Kind of like how list price means everyone pays the same price for a car? What would happen is more of what we already see: tons of addons being pushed, rebates or other ways to adjust prices for some people without lowering them, random specialists and unnecessary services being pulled in relying on the fact that most people don’t realize they can and should say no, and a whole industry of people finding ways to say you had some obscure complications not covered by the standard price. Look at it from an economic incentive standpoint: Americans pay 2-3 times more for the same service. That is a huge amount of money, and it ensures that rooms full of smart people will be working to ensure that their employers continue to get it.
  - bushbaba 5y ago
    Flip side you can actually shop around for the best car price. Can’t even do that at us hospitals
    - acdha 5y ago
      Exactly - it’s not a normal market and there are hard limits preventing it from ever working like that, no matter how many people desperately try to pretend otherwise because it’s personally profitable for them.